Orthopedic Nursing: Interview with Estrella Montes, RN, ONC

My Specialty

Orthopedic Nursing: Interview with Estrella Montes, RN, ONC

Casa Colina Hospital

By Keith Carlson, RN, BSN, CPC, NC-BC
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Estrella “Star” Montes, RN, ONC
Certified Orthopedic Registered Nurse
Casa Colina Hospital and Centers for Healthcare, Pomona


Tell us a little about the trajectory of your nursing career.

I was previously in the military, working as a Navy corpsman. I was responsible for running a lab in a small hospital. I worked with an amazing team of nurses and corpsmen. The teamwork that I witnessed between the nurses and other staff was inspiring. When they ran codes or cared for patients, it was impressive to observe how they worked together, learned from one another and always wanted to improve the way things were done. Their dedication and curiosity inspired me to go to nursing school when I completed my military service.

When I began nursing school, I just loved it. In order to support myself, I worked as a lab tech throughout my nursing education. I graduated with my ADN and was employed as a nurse within two months of graduation. I went straight into med-surg and orthopedics. I’ve generally chosen employment in smaller community hospitals. I like the way that smaller facilities reach out to the people in their areas.

Here at Casa Colina, we host community health classes, conduct outreach and otherwise connect with the local residents who rely on our hospital for their healthcare. I currently work on a combination med-surg/ortho/telemetry floor, although I’m certified in orthopedics and that’s my nursing specialty of choice.

What do you like about orthopedic nursing?

This specialty has come so far over the years, especially in the care of total joint replacement patients. It’s now more patient- and family-centered than ever. We involve the whole family through education and pre-op classes. We educate them about surgical expectations, labs, the pre-op workup and what they can expect from their hospital stay and their recovery at home.

We let patients know that once the surgery is done, we’re going to have them up and out of bed, generally on the same day. We keep them very busy while they’re in the hospital.

Total joint replacement patients are typically fairly healthy. They’re choosing to do this elective surgery in order to increase their quality of life and their ability to do the things they love to do. They’re generally active people who work, go on cruises and travel, but feel limited in what they can do because of their aching joints. After surgery, patients often say they can’t believe they waited so long. I like seeing them recover and have significantly improved function and mobility. It’s very satisfying.

How has technology impacted orthopedics?

What’s exciting right now is the implementation of robotically assisted orthopedic surgery. The orthopedic surgeons at Casa Colina utilize the Mako robot for partial knee replacements. This technology allows for more precise placement of the implant with less damage to surrounding tissue, resulting in less postoperative pain and a shorter recovery.

Our partial knee replacement patients sometimes go home the same day. Hip and total knee replacement patients typically go home on post-op day one. Infection rates are down, DVT [deep vein thrombosis] prophylaxis is robust and national safety protocols are consistently reached and exceeded. In terms of pain management, the multimodal pain approach has radically changed the nature of the game.

Every surgeon does things his or her own way, but we use spinal and general anesthesia as well as numbing blocks, femoral nerve blocks and a newly introduced medication that infiltrates directly into the tissue within the joint space. Neurosurgeons are starting to use this drug for spinal surgeries.

Are hips and knees the main focus of your work?

The vast majority of our surgeries involve the weight-bearing joints. Only a fraction of our surgeries involve shoulders and elbows.

Tell us about orthopedic nursing certification.

In order to obtain certification as an orthopedic nurse, you need two years of nursing experience and about 1,000 hours specifically in orthopedics. Earning and maintaining your certification requires you to remain up to date on your continuing education and recertify every five years. Seventy hours of your CE units must be orthopedic in nature.

They’re very specific about that! Casa Colina is actively encouraging a large number of its nurses to pursue certification. An orthopedic doctor can often tell the difference between a nurse who is ortho-certified and one who is not. To maintain my certification, I attend as many conferences as I can so that I can continue to learn new approaches and innovations. Hoag Orthopedic Institute is always an excellent choice and there are also many high-quality online CE classes and webinars.

How do you approach your patients and their recovery?

I tell my patients that I’m going to come on strong, be tough and really push them post-op. They can tell me if I need to calm down, but I want them to be up to par in their healing process. I remind them that I’m pushing for them to achieve the improved quality of life and function that can be theirs if they’re willing to work for it.

Post-op pain is always an issue and I’m not shy about sharing my recommendations and educating patients about their regimens. I try to stay away from IV narcotics in order to prevent over-sedation. We want patients busy all day, and heavy sedation prevents the level of activity that they need for success and a quick return to their lives.

We set goals for our patients and remind them that even though it can be grueling, a mindset of hard work and determination will allow them to get home and resume a pain-free life that’s often more active than before their surgery.

What are your goals for the advancement of your career?

I’m now in a BSN program that I’ll complete in May 2017. There are so many more things I want to do and the BSN is an important step in the right direction.

I’d like to become a nurse practitioner specializing in outpatient orthopedic surgical patient management. I’ve already applied for NP school and hope to begin in the fall of this year. I’d love to support patients in planning for and recovering from elective joint replacement surgery. I also love patient education and I’ll continue to help teach our community classes.

What do you recommend for nurses interested in orthopedics?

Look for facilities that are starting an elective joint replacement program and get involved. I recommend first working in med-surg — unless you can find a position in ortho, especially an elective joint program where you can really learn by doing. Surgeons are generally very specific in what they want from a nurse. You need to learn and gain their trust by building a collaborative relationship.

Some facilities will support you in seeking certification, which is something that can truly benefit your practice. Orthopedic nursing is a very satisfying nursing experience. I love working with my patients.

Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.

This article is from workingnurse.com.

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